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Case report
Fatal Clostridium septicum febrile neutropenia during adjuvant chemotherapy for early breast cancer
  1. João Moreira-Pinto1,
  2. José Luís Passos-Coelho1,
  3. Fabio Lopes1,
  4. Monica Ataíde2 and
  5. Paulo Oliveira3
  1. 1Department of Oncology, Hospital Beatriz Ângelo, Loures, Portugal
  2. 2Department of Radiology, Hospital Beatriz Ângelo, Loures, Portugal
  3. 3Department of Surgery, Hospital Beatriz Ângelo, Loures, Portugal
  1. Correspondence to Dr João Moreira-Pinto; joaopamp{at}gmail.com

Abstract

We report the case of a 76-year-old female patient with early breast cancer (hormone receptor-positive erbb2 amplified) that had started adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH). Eight days after the first cycle of TCH chemotherapy, the patient was diagnosed with grade 1 oral mucositis, treated conservatively. The next day she started with nausea, vomiting, chills and fever, followed by a generalised tonicoclonic seizure. She presented to the emergency department with fever, hypotension and mild abdominal tenderness. Grade 4 neutropenia (370 μL/mL) and severe metabolic acidosis were documented. An abdominal CT scan documented extensive ischaemic bowel changes, with gas in portal and mesenteric veins, and pneumoretroperitoneum. Despite broad spectrum antibiotics and fluid resuscitation, she died 4 hours after admitted to hospital. Blood cultures collected on hospital admission eventually grew Clostridium septicum bacteria, an extremely rare infection in patient with breast cancer.

  • breast cancer
  • hepatitis and other GI infections
  • malignant disease and immunosuppression
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Footnotes

  • Twitter @Joao_MPinto

  • Contributors All authors contributed extensively to the case. JM-P: Contributed to planning, conduct, reporting, conception and design, acquisition of data. JLP-C: Contributed to initial planning and conduction, also contributed to manuscript writing and extensive review. MA: Contributed to patient management, image selection and description, also contributed to manuscript writing and review. PO: Contributed to patient management, manuscript writing and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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